"The World and Japan" Database (Project Leader: TANAKA Akihiko)
Database of Japanese Politics and International Relations
National Graduate Institute for Policy Studies (GRIPS); Institute for Advanced Studies on Asia (IASA), The University of Tokyo

[Title] Basic Design for Peace and Health (Global Health Cooperation)

[Date] September 11, 2015
[Source] Ministry of Foreign Affairs of Japan
[Notes] Approved by the Headquarters for Healthcare Policy
[Full text]

In February 2015, The Government of Japan approved the Development Cooperation Charter in view of the challenges facing the international community today. The Charter sets out three basic policies: "Contributing to peace and prosperity through cooperation for non-military purposes," "Promoting human security," and "Cooperation aimed at self-reliant development through assistance for self-help efforts as well as dialogue and collaboration based on Japan's experience and expertise." In the Charter, international cooperation in the area of health is one of the priority issues. At the global level, health is also a primary goal area in the 2030 Agenda for Sustainable Development; one of its goals is to "ensure healthy lives and promote well-being for all at all ages."

Health is an indispensable component of human and social development; it not only constitutes a foundation for the lives of people around the world but also alleviates socioeconomic disparities. As has been seen in the spread of the Ebola virus disease, globalization comes with the growing threats of cross-border infectious diseases. This highlights the need to develop health governance at the global, national, and community levels as well as to strengthen health systems at the national and community levels, so as to address the threats. Such development in turn will help ensure the peace and stability of the world, including Japan. In addition, securing healthy workers and maintaining a sanitary living environment provide the basis for the private sector to conduct its activities, thereby helping to promote trade and investment.

Japan has excellent medical skills and technologies as well as health care systems that build on public-private partnerships all the way down to the community level. It also has a wealth of experience that has been accumulated in addressing such challenges as economic change, an aging population with a declining birth rate, and post-disaster reconstruction. Japan has exercised leadership at the global level in the area of global health through such opportunities as the G7/G8 Summits in 2000 and 2008, where Japan contributed much to improve infectious disease control, including the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). Furthermore, on those occasions and at other international fora, Japan has stressed the importance of developing global health workers, health financing, and information as the critical issues for the international community. In 2013, Japan announced the Strategy on Global Health Diplomacy. In the international community where health issues and actors are both being increasingly diversified, there are more and more expectations for Japan to utilize its expertise to play a leading role in global health. Meeting such expectations is in Japan's interests as well.

In 2014, Japan enacted the Act on Promotion of Healthcare Policy with a view to establishing a society in which people enjoy long and healthy lives. Under the Act, the Government of Japan established the Headquarters for Healthcare Policy and prescribed the Healthcare Policy. The Healthcare Policy includes facilitating overseas expansion in the healthcare and medical care sector as one of the key actions. Specifically, it was stated that giving adequate consideration to the situation in each country, Japan will provide drugs, medical devices, medical technology, and medical services to emerging and developing countries, as well as provide cooperation in the construction of medical and nursing care systems, thereby building mutually beneficial relationships in the healthcare field.

In light of the above, the Headquarters for Healthcare Policy hereby approves the Basic Design for Peace and Health (Global Health Cooperation) with a view to further contributing to global efforts to address health issues by fully mobilizing Japan's experience and expertise.

1. Policy Goal

In order to create a society that ensures health security for all and is resilient to external factors such as public health emergencies and disasters, most notably the outbreak of infectious diseases, Japan will not only increase its efforts to prevent and control such diseases but also strengthen its health systems as a whole. Ultimately, Japan will seek to help achieve universal health coverage (UHC) that ensures affordable access to basic health services for all whenever they need them throughout their lives. It will also aim to help other countries in the world to address various health issues by taking advantage of its experience, expertise and technical capabilities and dispatching personnel as appropriate.

2. Basic Policies

(1) Promoting development cooperation in health based on the concept of human security:

A. Building a resilient health system and establishing health security

In a globalizing world today, infectious disease and other health issues can easily spread beyond national borders and seriously affect the international community as a whole. The recent outbreak of the Ebola virus disease highlighted the need to strengthen global health governance so as to address public health emergencies in a timely and effective manner. Large-scale natural disasters have a major impact on developing countries and even their neighboring countries, causing health hazards for many people and otherwise affecting them seriously. In particular, negative effects of a vulnerable health system in a country or community can reach other regions and countries and threaten people's safety. Building a resilient health system during normal times will reduce the chance of an emergency happening or minimize the damage of an emergency. This in turn will support health security for individuals, communities, countries, and the world, and, by extension, help achieve human security. For this reason, Japan will join forces with the international community to focus on contributing to strengthening global health governance for addressing public health emergencies, including tightening infectious disease control, as well as on assisting developing countries in building a sustainable and resilient health system. At the national level, Japan will focus on developing a system for a more timely mobilization of human resources in times of emergency.

B. Contributing to quality growth and poverty eradication through assistance in the health sector:

Health is an essential sector in giving shape to the principle of human security, which pursues the happiness and dignity of individuals. People's health will make it possible to unlock the potential of individuals, galvanize society, support quality growth, and help eradicate poverty through such growth. It is important to ensure affordable access to basic health services for all whenever they need them throughout their lives. Japan will therefore continue its efforts to mainstream UHC in the international community and focus on extending assistance needed to achieve UHC. At the same time, Japan will address specific issues that must be resolved to achieve UHC. Japan will also focus on assistance in nutrition improvement, water and sanitation, and other aspects that will directly lead to disease prevention. Furthermore, it will consider opportunities for synergy with assistance in education, agriculture, and the development of infrastructure, including roads and power grids so as to comprehensively accelerate the poverty eradication of partner countries and the health improvement of people.

C. Achieving UHC that will "leave no one behind":

In the world today, there still exist fragile states, as well as vulnerable groups even within countries that have achieved a measure of economic growth. Human security, the guiding principle for Japan's development cooperation, will not be realized as long as these people are left behind. UHC, which will not leave any individual behind, is therefore important as it focuses on each and every individual, especially poor people, children, women, persons with disabilities, senior citizens, refugees and internally displaced persons, ethnic and indigenous people, and otherwise vulnerable groups. Japan will continue to place emphasis on health assistance that targets women in particular. Japan will also pay attention not only to low-income countries but also to the poor in middle-income countries, as well as health disparities within a country. In extending health assistance, Japan will take into account issues that are associated with changes in demographic and disease structures. It is also important for Japan to focus attention on social determinants of health and offer inclusive and tailored assistance that will contribute to better health of vulnerable groups.

(2) Development cooperation that capitalizes on Japan's experience, technology, and expertise:

In addressing various health issues, Japan has developed capable human resources, accumulated expertise, developed technologies, and improved institutions. Japan, which is becoming an super aging society ahead of the rest of the world, is a pioneer in the challenge to extend healthy life expectancy (the length of time during which people can live without health problems restricting their daily life). To make effective use of such experience in solving global health issues, the Government of Japan will accept input from various actors, including the private sector, and work with universities and research institutions to utilize expertise that has been developed in their academic research. Japan will offer integrated assistance: it will combine physical assistance (e.g. the construction of hospitals and the provision of drugs and medical devices) with non-physical assistance (e.g. the operational management, human resources development and institution building). Taking advantage of its technology and expertise, Japan will promote measures to solve global health issues through innovation.

(3) Priority policy issues by region:

Japan will provide development cooperation in health in line with the "priority policy issues by region" of the Development Cooperation Charter. In the process, attention will be paid to the relevance of moves toward regional integration, actions at the regional level, and efforts to strengthen inter-regional connectivity. Special attention should be paid to region-specific policy issues as shown below:

A. In Southeast Asia, Japan will strengthen measures against both infectious and non-communicable diseases while taking note of population aging and other demographic changes and increasingly diversified health needs. With a view to achieving UHC in southeast Asian countries, including the Mekong countries, Japan will focus its development cooperation in health on improving health service standards (including improving access in rural areas), disease prevention, and nutrition improvement.

B. In South Asia, Japan will continue to focus on improving health service standards and access, particularly in the area of maternal and child health, as well as on ameliorating the public nutritional status. In light of the epidemiologic transition, development cooperation in health will be designed to accommodate both non-communicable and infectious diseases.

C. In East Asia, Central Asia, and the Caucasus, Japan will extend assistance for health issues, meeting the needs of each country, including maternal and child health and measures against non-communicable diseases, while taking note of intra-regional disparities.

D. In Africa, Japan will focus on nutrition improvement and maternal and child health to improve access to basic health services in view of the need to promote UHC as advocated in the process of the Tokyo International Conference on African Development (TICAD). Mindful of the need to address infectious disease control, which continues to be an important issue, Japan will assist in building a resilient health system aimed at forestalling infectious disease outbreaks and other public health emergencies, while tackling the currently occurring infectious diseases, based on the experience of addressing the epidemic of the Ebola virus disease in West Africa.

E. In the Middle East, Japan will help improve access to health services for refugees and internally displaced persons, who are increasing in number amid destabilizing political and security conditions in the region, as well as other vulnerable groups, including the poor. In countries with a relatively high income, Japan will also work to support the promotion of Japan's excellent medical technologies.

F. In Latin America, Japan will extend cooperation, bearing in mind the needs of improving access to health services for the poor, taking note of the remaining internal disparities. In countries with a relatively high income, Japan will also work to support the promotion of Japan's excellent medical technologies.

G. With respect to small islands countries in Oceania, in small island developing states in the Pacific, the Caribbean and other regions, Japan will pay attention to the vulnerabilities that are peculiar to such countries. Japan's assistance will also accommodate the control of non-communicable diseases (NCDs), a major issue in Oceania.

3. Implementation Principles and Arrangements

In implementing this Basic Design, Japan will conform to the implementation principles and arrangements that are stipulated in the Development Cooperation Charter. In view of the recommendations in the report entitled Evaluation of Japan's Contribution to the Achievement of the MDGs in the Health Sector, Japan will conduct selection and concentration in terms of geographical area and sector and maintain coordination among donors to scale up its assistance for more effective health services. In cooperation with countries in Asia and other regions that it has long assisted, Japan will expand the scope of its development cooperation for African and other countries with lower health standards as well as countries that have been rendered vulnerable by conflicts or natural disasters.

(1) Strengthening the partnership with health actors:

Given that health issues, development actors, and financial sources are increasingly diversified, Japan will work more effectively with international and regional organizations, civil society, non-governmental organizations (NGOs), and private companies. Special attention will be paid to the following types of partnership:

A. Partnership between and among governments and government organizations:

In order to make the most of its experience, technology, and expertise to address various global health issues for effective assistance, it is crucial for Japan to strengthen partnerships between and among the ministries and agencies concerned and implementing organizations and promote cross-sectorial efforts. From this perspective, the government and government organizations will work as one to provide integrated development cooperation in global health based on this Basic Design as approved by the Headquarters for Healthcare Policy headed by the Prime Minister, who serves as the Director-General of the Headquarters. For this purpose, the Task Force for Global Reach of Japanese Medical Technology and Services, under the Headquarters for Healthcare Policy, will take charge of information sharing and coordination among the government and government organizations.

B. Public-private partnership:

Japan's development cooperation in health will be designed to utilize the private sector's excellent experience, technology and expertise in addressing global health issues and serve as a catalyst for expanding business activities. The Government of Japan will work with Japanese companies, health care institutions, local governments, and universities and research institutions to implement a range of projects – including those for training health workers, establishing a health care law and other institutions, and creating an environment conducive to attracting health-related investment – in an integrated manner in all phases, from project design to implementation.

C. Partnership with civil society:

It is important to take a tailor-made approach in implementing development cooperation in health, in particular at the community level, to meet the needs of recipients in both hard (physical) and soft (non-physical) aspects. To this end, it is essential to take stock of various views and requests in the field in detail and work closely with local residents and community organizations to strengthen health systems at the community level. From this perspective, the Government of Japan will work with NGOs and civil society organizations (CSOs) in and outside of Japan that have experience, technology, and expertise in extending community-based assistance as well as necessary resources and an adequate track record of cooperation. In designing development projects, the Government of Japan will also consider working with NGOs that are already active in the project areas, where appropriate.

D. Partnership with international and regional organizations:

The Government of Japan will continue its partnership with international and regional organizations that have particular expertise, impartiality and networks of their own as well as its assistance in the health sector through these organizations, seeking synergy by combining its bilateral cooperation programs and projects with such assistance in collaboration with multilateral organizations. In addition, the Government of Japan will work with the international community, especially international organizations, to promote UHC and other health policies to which Japan attaches importance.

E. Partnership with other donors as well as the governments of emerging and developing countries:

From diplomatic and other perspectives, Japan will continue to promote coordination with other donors and emerging countries in development cooperation in global health. In implementing its global health policy, Japan will make effective use of the experience, technology, expertise, and human resources and networks that have been accumulated in partner countries in the long history of Japan's assistance to these countries. Japan will continue triangular cooperation in partnership with emerging countries, as such cooperation has proven effective. Furthermore, Japan will take advantage of International Health Partnership Plus (IHP+) and other partnership frameworks in global health for more effective development cooperation.

F. Solidifying human resources and intellectual foundations for global health in Japan:

Under industry-government-academia collaboration, Japan will encourage the development of human resources that have expertise in global health. Such human resources development (HRD) will involve not only the government and government organizations but also consultants, researchers, universities and their students, private companies, NGOs and CSOs. Japan will offer more opportunities for these human resources to play an active role in Japan and abroad. It will also build institutions and develop systems for this purpose. Special emphasis will be placed on such issues as ensuring quick responses and mobility, deepening of expertise, accumulation of knowledge, improvement of survey and research capacities, HRD, and improving the system for emergency humanitarian assistance.

2. Promoting effective and efficient development cooperation:

In cooperation with various health actors, Japan will mobilize its resources to take a more strategic approach so as to engage in the development cooperation cycle of policymaking, implementation and evaluation of cooperation in health in an integrated manner.

A. Policy and project design:

In the process of project formulation, Japan will seek to design projects that suit partner countries through dialogue and collaboration. Japan will take more opportunities to make suggestions through dialogue with these countries, including policy consultations, while respecting the ownership of the countries. In doing so, Japan will see to it that the project design process will involve collaboration with a wide range of stakeholders in partner countries and respect their self-help efforts, since development cooperation in health calls for special attention to women and cross-sectorial and broader-based perspectives. In identifying goals and policies for each project, Japan will respect the Country Assistance Policy for the partner country in question, its health policies and conditions, this Basic Design, international guidelines, and scientific evidence.

B. Implementation:

Health issues facing developing countries are diverse, and so are their economic conditions and health systems. For a sustainable solution, it is important to support self-help efforts by partner countries and offer cooperation aimed at self-reliant development based on the principle of development effectiveness. From this standpoint, Japan will organically combine technical cooperation, government loans and grant aid to reflect the partner countries' economic conditions and health systems and implement these modalities in a timely and flexible manner. In the process, Japan will take note of the possibility of collaboration between its development cooperation and financial and other cooperation from other donors and the private sector. To make such efforts possible, Japan will work to improve predictability in cooperation with stakeholders in and outside of Japan in terms of short-, mid- and long-term directions for development cooperation. Through such cooperation, Japan will seek to contribute to the efficient and effective management of health funds of each country by, for example, strengthening its health system governance (decision-making and consensus-building mechanisms with regard to how to secure, allocate, and evaluate financial, human, and other resources), in addition to financial contributions.

C. Monitoring and Evaluation:

Japan will conduct evaluations at the optimal timing both at the policy level (towards assistance for the health sector of a partner country) and at the project level, with adequate consideration given to the PDCA cycle (Plan, Do, Check, Act cycle, which represents a feedback mechanism). Results of the policy-level evaluations will be fed back to project implementation and the process of formulating future global health policies to increase effectiveness and efficiency in cooperation projects. During the project implementation process, Japan will monitor and review appropriate indicators which were carefully identified, using methods such as operational research, to improve cooperation projects. Japan will develop indicators for project-level evaluation based on the Global Reference List of 100 Core Health Indicators of the World Health Organization (WHO) and indicators proposed in the 2030 Agenda for Sustainable Development and will consider applying methods such as impact evaluations in verifying its outcomes.

D. Communication to the public and the international community:

Information on the implementation status and evaluation of Japan's development cooperation in global health should be communicated in a timely and transparent manner. In view of the importance of global health policies and accountability for them, it is important to provide the public with adequate information on such aspects as outcomes and international evaluation. It is also important to raise awareness of the international community toward Japan's development cooperation in global health and its outcomes. From these perspectives, Japan will seek proactive communication to the public.

4. Measures for Assistance

(1) Building a health security that is resilient to external factors such as public health emergencies and disasters

In cases of public health emergencies or disasters, it is important to minimize health hazards, continue to provide other normal health services, and limit the socioeconomic impact to a minimum, thereby contributing to early recovery and reconstruction. The recent outbreak of the Ebola virus disease was due in part to inadequate performance of global health governance and vulnerable health systems of the countries hit by the disease. A lesson to be learned from this experience is that global health governance should be strengthened so as to encourage the governments in question, the international organizations concerned, donors, private companies, and NGOs to work together and make the most of their own expertise to address public health emergencies. Based on this recognition, Japan will participate in the global discussions at such fora as the United Nations, the World Health Organization (WHO), and G7 with input from experts in Japan and play a leading role in developing global health governance. Japan will also make active contributions to support funding mechanisms for emergencies. In particular, Japan will lead assistance in the aspects for which it enjoys a competitive advantage such as disaster risk reduction and disaster medicine. At the national level, Japan will assist individual countries in strengthening measures against infectious diseases and building resilient health systems from a long-term perspective, in cooperation with international organizations. Specific focus will be placed on designing health systems, training health workers at the national and community levels, and supporting the implementation of the WHO's International Health Regulations (IHR). In the process, Japan will give consideration to women and support reconstruction efforts, including those efforts to recover health systems

In cases of emergencies, Japan will extend an effective and efficient combination of personnel assistance, including the dispatch of Japan Disaster Relief (JDR) teams, in-kind assistance, and financial assistance, in coordination with other donors, the international organizations concerned, and NGOs. To this end, Japan is constructing a system for the dispatch of Japanese personnel to infected countries and territories in a timely manner.

Specific measures may include the following:

1. Helping to prevent infection outbreaks in affected countries and territories by strengthening assistance to international organizations

- Contributing to discussions on global health governance at such fora as WHO and the World Bank (WB)

- Assisting the implementation of IHR and the strengthening of infrastructure for human resources for development in international infectious disease crisis management (GOARN)

- Considering financial contributions, including those to the WHO Contingency Fund

- Considering financial contributions to the development of WB's Pandemic Emergency

- Financing Facility (PEF)

- Considering financial contributions to the Catastrophe Containment and Relief Trust of the

- International Monetary Fund (IMF)

- Working with and holding policy dialogues with the UN Development Programme (UNDP), the UN Children's Fund (UNICEF), the UN Population Fund (UNFPA), and other implementing agencies

2. Implementing measures against infectious disease in close cooperation with international organizations

- Strengthening the measures against the three major infectious diseases through the Global Fund (Note: About 10,000 people died of the Ebola virus disease in 2014, while some 3.6 million died of the three major infectious diseases in 2013 according to WHO.)

- Reinforcing vaccination activities by Gavi, the Vaccine Alliance

- Reinforcing activities for the research and development of new drugs by the Global Health Innovative Technology Fund (GHIT)

3. Strengthening measures against infectious diseases by strengthening health systems in developing countries

- Strengthening health systems and promoting UHC in Asia and Africa, through utilizing ODA by synegetically combining grant aid, government loan and technical cooperation

- Assisting in strengthening health systems through the Global Fund (wider utilization of human resources that have been developed in the programs of the Global Fund and other organizations with more emphasis on the vertical approach)

- Building the capacities of inspection, surveillance and quarantine towards the implementation of IHR in developing countries (including capacity building and networking for research institutions and hub organizations Japan has assisted thus far)

- Reinforcing assistance for the implementation of IHR through the Global Health Security Agenda (GHSA)

- Assisting cross-sectorial reconstruction efforts based on the concept of "Build Back Better"

4. Constructing a system for the timely dispatch of personnel to infected countries and territories

- Examining effective assistance to infected countries

- Constructing a framework for dispatching the JDR Infection Control Team, and procuring, managing and maintaining materials and equipment needed for such dispatch

* Promoting HRD through the Infectious Disease Emergency Specialist Training Program and other measures

* Developing a human resource registration system for JDR Team

* Identifying domestic human resources specializing in infectious disease (including medical specialists) who are in demand globally, and studying ways to scale up the quality and quantity of these resources (including ways to train and register global health workers)

- Working with WHO and other international organizations

* Strengthening the collection of infectious disease information through international organizations such as WHO and Centers for Disease Control and Prevention (CDC), etc.

* Building up the capacities of information collection and analysis and examination) at the National Institute of Infectious Diseases

* Developing the capacity to identify infectious diseases of international concern

- Exploring measures to develop a system for responding to the infection of Japanese personnel dispatched overseas, etc. (response when they have been deployed and the transportation to Japan, etc.)

(2) Seamless utilization of essential health and medical services; promotion of UHC throughout life

Japan will seek to achieve UHC that ensures affordable access to basic health services for all whenever they need them throughout their life. Such services should include all kinds of basic health services, including nutrition improvement; maternal and child health; sexual and reproductive health; control of HIV/AIDS, malaria, tuberculosis, polio and other infectious diseases; control of non-communicable diseases (NCDs); health and nursing care for the elderly; and oral hygiene. To ensure the delivery of all these basic health services, Japan will work to reinforce the elements of a health system such as leadership and governance, health information, health workers, and medicines and medical devices. It will also work to scale up basic health services and make them more affordable and available to more people. To ensure affordable access to these basic health services, it will achieve three targets; expansion of the breadth of basic health services, increase of the target groups for these services, and decrease of the financial burden of service fees. To ensure affordable access to these basic health services for all, it is essential to establish sustainable and equitable health financing. In developing these mechanisms, attention should also be paid to service delivery systems (the community-based integrated care system) that accommodate growing needs in response to changes in lifestyles and an aging population (dementia, mental health, non-communicable diseases (NCDs), etc.). Such assistance should involve work to actively share Japan's experience, technology, and expertise with regard to the universal national health insurance system and Data Health. To explore ways to achieve UHC, relevant studies to date should be considered, including studies by the Japan-World Bank Partnership Program on Universal Health Coverage and the Global Health Working Group (GHWG) for the G7 Ise-Shima Summit in 2016. In addition, Japan will work to identify relevant experience and expertise gained from Japan's global health policy to date and communicate them to the world. It will also work to ensure that they are incorporated into the process of forming the principles of and trends in global health policy. Furthermore, Japan will take advantage of international fora – including the G7 Ise-Shima Summit, the G7 Health Ministers Meeting in Kobe, and TICAD – to lead the discussion toward promoting UHC and solving health issues.

Specific measures may include the following:

1. Assisting developing countries in strengthening their health systems toward achieving UHC

- Assisting individual countries in developing and implementing their health policies

- Supporting the dissemination of the community-based integrated care system and regional healthcare visions

- Supporting the establishment of public health center system

- Supporting the accumulation of basic health information through family/resident registers, demographic surveys, etc.

- Supporting the collection and utilization of health information using ICT

- Supporting government officials in building their capacity and health care providers in improving their skills in the health sector

- Supporting the training of volunteer health workers

- Conducting concept studies of basic health services and disseminating their findings to the world

- Supporting the development of basic health infrastructure, including the construction of health care facilities and the provision of medical devices and products

- Providing drugs and medical devices for the purposes of prevention, diagnosis, treatment, and rehabilitation

- Supporting the development of economic infrastructure that may help to improve hospital access and overall health conditions.

- Providing training on how health and nursing care financing works

- Encouraging research on health financing systems aimed at achieving UHC

- Reinforcing and carrying out policy loans that are available on condition that some targets toward achieving UHC are met

- Supporting disease control with loan conversion and other public-private mechanisms

- Contributing to efforts that help to achieve UHC through the Global Fund, Gavi, the Vaccine Alliance and other organizations.

2. Addressing health issues

- Further improving maternal and child health in collaboration with the Global Financing Facility

- Promoting continuum of care for maternal and child health through the dissemination of the Maternal and Child Health handbook and other mechanisms

- Encouraging preventive interventions to reduce the burden of disease (e.g. prohibition of smoking)

- Promoting health check programs that contribute to early detection and treatment of disease

- Supporting measures to prevent and treat NCDs, including information campaigns

- Assisting in the fields of dementia and mental health

- Supporting nutrition improvement through public-private partnerships, including the establishment of a platform for nutrition improvement

- Providing assistance to projects designed to reduce child and maternal mortality rates and combat AIDS, malaria, and tuberculosis that is linked with their performance in MDGs

- Supporting the development of a basic health service package

- Supporting efforts to eradicate polio

3. Reinforcing development cooperation that capitalizes on the expertise of international organizations, NGOs, etc.

- Contributing to UNFPA and the International Planned Parenthood Federation (IPPF) in the areas of reproductive health, and population and development, with a special focus on their activities that consider the special needs of women

- Reinforcing assistance for the activities of UNDP, UNICEF, WB, etc. that contribute to UHC

- Contributing to the Global Fund and the Gavi, the Vaccine Alliance in their efforts for infectious disease prevention

- Supporting Japanese NGOs in health and sanitation through Grant Assistance for Japanese NGO Partnership Projects, the JICA Grassroots Technical Cooperation Projects, and other ODA schemes

- Assisting health and sanitation areas through local NGOs, etc. with the Grant Assistance for Grass-Roots Human Security Projects

4. Contributing to the global discussion toward UHC

- Promoting UHC and putting it on the global agenda by taking advantage of international fora such as the UN General Assembly, the G7 Ise-Shima Summit, the G7 Health Ministers Meeting in Kobe, and TICAD

- Presenting Japan's programs and projects in global health and offering model cases through the publication of their evaluation results

- Conducting R&D of tools for implementing UHC through joint research with international organizations

(3) Making effective use of Japanese health workers, expertise, drugs, medical devices, medical technologies, and medical services to strengthen health systems and ensure health security

Japan will take advantage of the human resources and expertise it has developed in the process of addressing various health issues to strengthen health systems in partner countries. Given the need to ensure that central and local government officials can perform their function of developing and implementing health policies, Japan will make necessary arrangements to develop human resources in Japan and other countries, strengthen their capacities, and dispatch Japanese personnel abroad upon request from developing countries, thereby contributing to development cooperation in global health in general and health security arrangements in particular.

Japan will contribute to improved health and medical levels in emerging and developing countries by making proactive use of Japanese drugs, medical devices, technologies and services as well as assisting Japanese health care institutions and companies in conducting their sustained activities overseas. It will also encourage public-private partnership efforts to make medical products available in developing countries through innovation that takes advantage of Japan's R&D prowess. To this end, Japan will work with other countries to deepen their understanding of Japanese pharmaceutical regulations and standards regarding clinical trials, pharmaceutical approvals, and other aspects and promote their international harmonization, thereby strengthening relationships of trust at the national level. Japan will also assist in developing structures and international networks for international joint clinical research and for Japanese institutions participating in clinical trials in such research. Taking advantage of this opportunity, Japan will conduct research on guidelines for evaluating the effectiveness and safety of drugs, medical devices, technologies, propose developing relevant international standards, and promoting their international harmonization. Furthermore, Japan will support the development of an industry-academia-government platform for drug development for Asia as a whole. It will also encourage the active utilization of information and communications technology (ICT), including telemedicine. These efforts can create new industrial activities that will help create a society in which people enjoy a long and healthy life* and encourage more such activities abroad. This in turn can contribute to the improved quality of health care in developing and emerging countries, and support Japan's economic growth and national development as a country with advanced medical and welfare system. (* A case in point is the efforts by Kanagawa Prefecture to create "ME-BYO industry and cutting-edge medical industry" and communicate this initiative to the world.)

Specific measures may include the following:

- Contributing to improved health care standards in partner countries by establishing Japanese-style medical centers

- Supporting the overseas promotion of drugs, medical devices, services, etc. through HRD and institution building

- Reinforcing assistance to the research and development of new drugs for neglected tropical diseases (NTDs) and other infectious diseases by taking advantage of the expertise owned by Japanese private companies, universities, and research institutions through GHIT

- Providing technical training for Japanese drugs and medical devices, technologies, and services as well as support for their distribution

- Promoting innovation through joint research between research institutions in developing countries and those in Japan via the Science and Technology Research Partnership for Sustainable Development (SATREPS), etc.

- Providing facilitating support for obtaining WHO certification of drugs and medical devices

- Supporting effective disease prevention and health management as well as the delivery of uniform medical services through telemedicine, with the ICT-assisted registration of health information, the use of electronic health records, and support for improving e-health.